3D Slicer辅助下神经内镜对比钻孔引流治疗幕上高血压性脑出血：疗效与安全性的系统评价

3D Slicer-Assisted Neuroendoscopy versus Burr-Hole Drainage for Supratentorial Hypertensive Intracerebral Hemorrhage: A Systematic Review of Efficacy and Safety

摘要: 幕上高血压性脑出血是神经外科高致死致残率的急重症，微创手术联合影像导航技术已成为治疗热点。3D Slicer作为开源医学图像处理平台，可精准规划血肿定位与穿刺路径，但其辅助下神经内镜与钻孔引流两种微创术式的优劣尚缺乏系统比较。本文通过系统综述，全面评估两种术式在血肿清除率、手术时间、住院时间、神经功能恢复及术后并发症等方面的差异。现有证据表明，3D Slicer辅助神经内镜手术在血肿清除率方面显著优于钻孔引流术，且在改善术后格拉斯哥昏迷评分、改善预后及降低颅内感染和总体并发症风险方面更具优势。然而，神经内镜手术操作时间可能略长于钻孔引流，且对术者技术要求更高。钻孔引流术虽操作简便快捷，但血肿清除效率较低，再出血风险相对较高。目前多数研究为回顾性设计，缺乏高质量随机对照试验，且3D Slicer辅助是否带来独立获益仍需验证。综上，3D Slicer辅助神经内镜手术在疗效与安全性上整体优于钻孔引流，适用于血肿体积适中、意识状态尚可的幕上高血压性脑出血患者，但未来需多中心前瞻性研究明确其长期获益与最佳适应证。

Abstract: Supratentorial hypertensive intracerebral hemorrhage is a critical emergency in neurosurgery associated with high mortality and disability rates. Minimally invasive surgery combined with image-guided navigation has become a treatment hotspot. As an open-source medical image processing platform, 3D Slicer enables precise preoperative planning for hematoma localization and puncture trajectory; however, a systematic comparison between neuroendoscopy and burr-hole drainage assisted by 3D Slicer is still lacking. This article provides a systematic review of the existing evidence to compare the two procedures in terms of hematoma evacuation rate, operative time, hospital stay, neurological functional recovery, and postoperative complications. Current evidence indicates that 3D Slicer-assisted neuroendoscopic surgery is significantly superior to burr-hole drainage in hematoma evacuation rate, and also shows advantages in improving postoperative Glasgow Coma Scale scores, enhancing functional outcomes, and reducing the risks of intracranial infection and overall complications. Nevertheless, neuroendoscopic surgery may require a slightly longer operative time and higher technical expertise from the surgeon. Burr-hole drainage is simpler and faster to perform, but its hematoma evacuation efficiency is lower and the risk of rebleeding is relatively higher. Most current studies are retrospective in design, and high-quality randomized controlled trials are lacking; moreover, whether 3D Slicer assistance provides independent benefits remains to be validated. In conclusion, 3D Slicer-assisted neuroendoscopic surgery appears overall superior to burr-hole drainage in terms of efficacy and safety for supratentorial hypertensive intracerebral hemorrhage patients with moderate hematoma volume and acceptable consciousness status, but future multicenter prospective studies are needed to confirm its long-term benefits and optimal indications.